Chapter 10: Rural Disabled Elders

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Chapter 10: Rural DisabledEldersElizabeth Depoy PhD & Stephen French Gilson PhDPublished online: 22 Sep 2008.

To cite this article: Elizabeth Depoy PhD & Stephen French Gilson PhD (2004) Chapter10: Rural Disabled Elders, Journal of Gerontological Social Work, 41:1-2, 175-190,DOI: 10.1300/J083v41n01_10

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Chapter 10

Rural Disabled Elders

Elizabeth DePoy, PhDStephen French Gilson, PhD

SUMMARY. In this chapter we focus on social work practice with ruraldisabled elders. After discussing the tension between nomothetic andidiographic thinking about populations, we advance a definition whichembodies both. Rural disabled elders are therefore a diverse set of mem-bers who both share some commonalities and are rich in their diversityand difference. To belong to this group, members must live outside of ur-ban areas, be advanced in age and experience, and exhibit at least oneatypical characteristic that carries an explanation which fits legitimatedisability determination by a formal source. We then advance an ap-proach to social work practice guided by the synthesis of two ideologies,self determination and legitimacy, and informed by systematic examinationand analysis of social problems that affect individuals and groups. We con-clude by advancing positive and negative principles for practice. [Article copiesavailable for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2003 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Disabled elders, rural elders, self-determination

[Haworth co-indexing entry note]: “Rural Disabled Elders.” DePoy, Elizabeth, and Stephen FrenchGilson. Co-published simultaneously in Journal of Gerontological Social Work (The Haworth Social WorkPractice Press, an imprint of The Haworth Press, Inc.) Vol. 41, No. 1/2, 2003, pp. 175-190; and: Gerontologi-cal Social Work in Small Towns and Rural Communities (ed: Sandra S. Butler, and Lenard W. Kaye) TheHaworth Social Work Practice Press, an imprint of The Haworth Press, Inc., 2003, pp. 175-190. Single or mul-tiple copies of this article are available for a fee from The Haworth Document Delivery Service[1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]].

http://www.haworthpress.com/web/JGSW 2003 by The Haworth Press, Inc. All rights reserved.

Digital Object Identifier: 10.1300/J083v41n01_10 175

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INTRODUCTION

Although we initially thought that this would be a straightforwardchapter to write, we soon found that we struggled with how to delimitthe boundaries and members of this group, and the issues of importanceto social workers. The complexity of who fits into the category of dis-ability, the slippery and differential meaning of elderly, the vast differ-ences among geographic areas that are considered to be rural, and thediversity of individual, family, small group, and cultural experience ineach and all three contexts can be confounding. Yet, we also recognizethe critical importance of being able to address the nature, social issues,and related needs of groups, since no policy, program or community re-sponse could possibly take into account the vast range of individual di-versity. We therefore approached our task from the perspective oftension and balance. That is to say, we present the tension betweennomothetic (general principles about groups) and idiographic (individ-ualistic) understandings of and responses to humans, and advance ananalysis and exemplars for balance between the two poles which we be-lieve can guide social workers towards thinking and action that helpcommunities become socially just and respectful environments for therange of human diversity. We begin with the task of defining our termsand then move to a discussion of social work with rural, disabled elders.We conclude with positive (what should be) and negative (what shouldnot be) principles for practice with rural disabled elders.

DEFINING OUR TERMS–WHO ARE RURAL DISABLED ELDERS?

While it is purposive and important to develop a generalized impres-sion of what we might mean by the category rural disabled elders, it isobligatory to avoid a simplistic at best and potentially harmful homoge-nization of the diverse range of members in this group (Hudson, 1997).Many taxonomies describing and explaining human experience havebeen and continue to be posited. Thus, categorization is a dynamic think-ing process (DePoy & Gilson, 2003) in which discourse and debate giverise to diverse conceptual frameworks which differ in their delineation ofcategorical boundaries, contexts, epistemological foundations, axiologicaldimensions, and ontology (Hutchison, 1999). Because of this complexityand the presence of three variables in our domain of concern, we beginour discussion by exploring each variable (rural, disability, and elder)

176 Gerontological Social Work in Small Towns and Rural Communities

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individually. We then synthesize the lexical definitions to delimit ourscope and to provide an understanding of the tension between the com-monalities that comprise the conceptual category and the diversity of itsindividual members.

RURAL

As a beginning point, we examine just what we mean by rurality. TheUnited States Census Bureau (2002) defines rural by what it is not. Ac-cording to the Census Bureau, rural is classified as “all territory, popu-lation, and housing units located outside of UAs [urbanized areas] andUCs [urbanized clusters]. The rural component contains both place andnonplace territory” (p. 1). Roughly, urbanized areas are defined asdensely settled areas that have census a population of at least 50,000people, commonly with 1,000 people per square mile, and with adjacentblock areas with at least 500 people per square mile. Urban clusters aresettled geographic areas that have a density of 2,500 to 49,999 people,consisting of blocks or block groups of at least 1,000 people per squaremile and adjacent blocks and block groups of at least 500 people persquare mile.

Consulting the census definition provides us with a point, but only astarting point for our consideration of the scope of the concept ofrurality. Unfortunately, while numerically clear, this approach to set-ting definitional boundaries and identifying essential elements of theconcept of rurality does not take into account the factors that are relevantand necessary to understanding rural experience and needs, including butcertainly not limited to economic activities, land values, political power,as well as primary language, educational opportunity, race, ethnicity, andcultural diversity. We all are aware that geographic areas that meet theCensus 2000’s definitional criteria for rurality exhibit tremendous con-trasts in culture, climate, regional median income, occupational or ca-reer opportunities, and land use patterns. It therefore follows that wemight expect vast differences in life opportunities, daily tasks, andavailability and accessibility of health and social service offeringsamong locations such as a winter snow ski resort in Maine, a coal min-ing town in West Virginia, a farm in Iowa, a cattle ranch in Wyoming,or an American Indian reservation in Arizona. Each of these geographicsettings provides both extraordinary opportunities for as well as uniquechallenges to daily life and experience.

Section III. Special Populations 177

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Although diverse, there are some commonalities among rural areasthat are relevant to social work and can be aggregated to produce a gen-eral definition that is useful for our discussion. Following the defini-tional approach of the Census Bureau, we also define rurality by what isnot. That is to say, rural denotes a geographic area that, in comparison tourban areas, is less populated and has a limited array of formal re-sources, including those relevant to social work, such as health and so-cial services. Although we highlight rural areas for what they are not forthe purposes of this paper, we do not mean to imply that rurality is notrich with natural and human resources and opportunity. Rather, defini-tion by comparison allows us to see what part of the literature on urbanareas does not fit the nature of rural geographies.

DISABILITY

Similar to the difficulty in identifying a single but useful definition ofrurality, defining disability provides confounding dilemmas that havebeen the source of debate and discourse for centuries (Longmore &Umansky, 2001). Looking back as far as ancient Greece, historical ac-counts reveal a nonlinear and multidirectional movement of the mean-ing of disability, spanning a continuum from the diagnostic-medicalapproach to an interactive complex person-in-environment perspective(Stiker, 1999).

The diagnostic approach to disability is based on medical explana-tions of individual human conditions. Accordingly, disability is definedas a long term to permanent diagnosed impediment that positions indi-viduals with disabilities as less able than those who can recover from ill-ness or who are non-disabled (Mackelprang & Salsgiver, 1997). As aform of biological determinism, the focus of disability in this definitionis on physical, behavioral, psychological, cognitive, and sensory inade-quacy, and thus disability is portrayed as a human characteristic situatedwithin the disabled individual (Shakespeare, 1996). In large part, the di-agnostic approach is based on the historic notion of illness advanced byParsons in the early 1950s in which an individual who was deviant anddeficient as a result of a diagnostic condition relinquished responsibilityin exchange for professional care (Goffman, 1963).

The constructed approach to disability is the set of models in re-sponse to the medically deviant view that locates disability in the envi-ronment external to the individual. While a condition is acknowledged,it is not necessarily undesirable, in need of remediation (Quinn, 1988)


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or even relevant to understanding the circumstance of disabled people.Moreover, the notion that all individuals have diverse conditions is cen-tral to this approach. Why some conditions can be constructed as dis-abilities (i.e., mobility impairments in which individuals cannot walk)and others are not (mild nearsightedness), despite being correctablewith adaptive equipment, is a fundamental question raised by thisframework.

Simply put, the diagnostic-medical explanation of disability placesthe locus of disability within the individual who has experienced illness,insult, or anomaly. This internal focus results in an interpretation of thedisabled individual as defective with reference to normative physicalbeing. The constructed lens, on the other hand, looks at factors externalto an individual that interact with diverse human conditions to create adisabling experience. Between these two views, numerous other explana-tions and understandings of disability exist, including ideas as extreme asdisability being caused by spiritual demonization of individuals (Gilson &DePoy, 2000).

An analysis of the multiple definitions of disability reveals defini-tional vagueness, in that no distinction is made among definitions thatapproach the construct of disability from the perspective of description,explanation, and value. Synthesizing the approaches allows an over-arching definition to be formulated. We therefore define disability as avalue judgment regarding the degree to which the explanation for atypi-cal human experience meets the legitimate criteria for a determinationof disability. This definition does not take a single stance on disabilityas internal characteristic or external barrier. Rather, the disabling factoris the judgment regarding the fit of the label and relevant responses toexplanations for why an individual or group lies outside of what is con-sidered to be typical (DePoy, 2002; DePoy & Gilson, in press).

ELDERLY

In defining the term elderly, we encountered many words or phrasesthat seemingly are used interchangeably but may not have equivalentmeanings. Here we distinguish elderly as a human attribute, elder as anoun for an individual who is elderly, and aging as a process. We agreewith Harrigan and Farmer (2000) that aging “begins at birth, continuesthroughout life, and marks the passage of years” (p. 26). However, whatchronological marker denotes the beginning of elderly is not as clear.As evidenced by even a cursory examination of agency, organization,


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and legislative policy, regulations, and program eligibility guidelines,what qualifies as the “legitimate age” beyond which one is an elder orelderly is both highly variable and determined by value. For example,the age for eligible membership in the AARP is 50; Medicare eligibilitybegins at age 65; individuals are eligible to begin receiving their Retire-ment Social Security benefits as early as age 62; and the determinationof an individual’s eligibility to retire from many white collar profes-sional positions is often based upon a mathematical formula that factorsin both the chronological age of the individual and the number of yearsthat the individual has been employed at the designated setting.

If we use chronology alone as the determinant of elderly status, wequickly realize the universe of confounding variables. Consider genderfor example. The issues, experiences, and potential needs of elderlywomen may be significantly different from those of men in the sameage range (Beckett, Schneider, Vansburger, & Stevens, 2000). Varia-tions and differences also exist when we consider characteristics ofrace, ethnicity, primary language, immigration status or land of origin,sexual orientation, faith and/or religions, educational attainment, eco-nomic status, or other individual or group characteristics, just to name afew. Further, because aging is intimately associated with the psycho-logical, social, spiritual, economic, and political dimensions of an indi-vidual’s and community’s life, when one becomes elderly is influencedby all of these variables as well (Minkler & Fadem, 2002).

Synthesized from the vast literature, we propose a generalized defini-tion of elderly as the chronological time of life which is advanced inyears and life experience. Furthermore, consistent with Minkler andFadem (2002), elderly individuals have experienced aging as a processof loss and gain over the lifespan and have a significant personal historyon which to reflect.

SYNTHESIS

From the three definitions above, we now have a basis for delimitingrural, disabled elders as individuals who live outside of urban areas,who are advanced in age and experience, and whose explanations for anatypical nature are determined by at least one formal source to fit legiti-mate eligibility criteria for disability. Thus, the distinction between ru-ral elders and rural elders who are disabled is the absence or presencerespectfully of an atypical phenomenon that is explained with a legiti-mately disabling rationale. Although the likelihood of need for support


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for an individual with a disability is higher than for a non-disabledcounterpart, we wish to clarify that the presence of a disability does notautomatically necessitate services, supports, or caregivers. We return tothis point later in the chapter.

Just to estimate the scope of individuals who may be members of thebroad category of rural disabled elders, 23% of those who attained orpassed the age of 65 now live in non-metropolitan areas, and of those,we can extrapolate from national data that approximately 55% (extrap-olated from 1997 report, Profile of Older Americans, Administration onAging, 2001) have at least one disability, with the higher age ranges re-porting increasingly higher rates of disability. Moreover, as aging pro-ceeds, the numbers reporting disability increase disproportionately (Admin-istration on Aging, 2001).

As we noted above, not all disabled individuals need assistance andthus, the numbers of individuals who are both disabled and report need-ing assistance is of relevance to our continuing discussion. The numbersof those reporting both expand exponentially from 8.1% of the totalpopulation at the age range of 65-69 to 34.9% of individuals aged 80and over, clearly highlighting the association between advancing ageand need for assistance (Administration on Aging, 2001).

And while a disproportionately high number of elders, regardless ofdisability status, indicate the need for help, distinguishing who is de-fined as disabled because of the aging process from who enters the eldertime of life already being disabled is important to consider in the currentclimate of categorical legitimacy for services. There are several reasonswhy. First, social workers can assist disabled elders to access the exist-ing resources that address their category membership. But second, be-cause current eligibility criteria for formal disability resources areanchored in nomothetically derived assertions of categorical needs, so-cial workers looking to the future are in a crucial position to question theefficacy of the current service structures. These too frequently miss theimportant idiographic range of diversity and individuality within themembership of rural disabled elders. The challenge for social workers istherefore to seek a balance between the nomothetic and idiographic ap-proaches to need of this population, among others. To accomplish thistask, the thinking process of problem identification, embedded withinthe ideologies of self determination and legitimacy, provide importantguidelines for identifying issues and related needs for rural, disabled el-ders, and for determining needed responses on the part of social work-ers. We turn to these now, beginning with ideology.


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SELF DETERMINATION AND LEGITIMACY IDEOLOGY

Self-determination is a phrase that has come to be used by profes-sionals to describe elements of progressive social, human, and healthservice work and by individuals to define a preferred approach to ser-vices, programs, organizations, policies, legislation, and research agen-das (Tower, 1994). The ideology illustrates the balance of nomotheticand idiographic concerns, in that it recognizes the importance of choicewithin the constraints of social, economic and political contexts.

Within the field of disability studies, the ideology of self-determina-tion places the disabled person at the “center of decision making andcontrol” (Tower, 1994, p. 101). We have modified this ideology for so-cial work practice with rural, disabled elders by suggesting that practicebased in self determination ideology is at least a two layered approach.To address immediate need expressed by rural, elder, disabled individu-als, social workers can identify and assist in the selection and organiza-tion of currently available resources. The second layer, focused on thefuture, is the obligation to systematically study and identify what socialwork and other community supports do not exist but are needed to re-solve social problems. And on the flip side, it is incumbent on socialworkers to study what does exist and eliminate the services that do notmeet the community needs, or perpetuate the growth of professionalpractice programs on the basis of the assumption that they are needed.Thus, social work practice guided by self-determination ideology isboth immediate and future directed since it moves selection into choice.Choice involves developing desired positive (expansion of what is pres-ent) and negative (elimination or absenting what is currently present)options that reshape a list from which existing options can be selected.The distinction between choice and selection is a critical one in thismodel, in that selection, while more advanced on the thinking contin-uum than nomothetically based solutions to normative problems, actu-alizes thinking as a shared responsibility where the only step conductedby providers alone is the initial delimitation of service and support op-tions. Choice is a thinking process in which existing options do not limitpossibilities, but rather provide the grounding upon which to ascertainwhat else may be needed, decreased and/or eliminated to resolve identi-fied social problems. Choice is idiographic in that it not only places anindividual in control of his or her selection of options, but provides theforum to envision service and support options that are not available.This point is critical for social work with rural disabled elders.


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Within the service system, self-determination requires that providersadjust their relationships with rural disabled elders and recognize thatagency policies and procedures based on traditional paradigms of pro-fessional expertise commonly serve to diminish selection and choicenecessary for self-determination (Freedberg, 1989). Fundamental toself determined human services is the recognition that rural elders withdisabilities are the experts on their own lives and provide the idiographicunderstanding of their own needs. Within this conceptualization, the ru-ral, elder, disabled person moves out of the role of client, patient, or recip-ient of services (Tower, 1994), to occupy the position of an educated,thoughtful, and informed user of services. This redefinition serves toplace the elder in control of and directing his/her services (Brooke,Wehman, Inge, & Parent, 1995) as well as defining the range of“non-service” needs, desires, and interests.

A major consideration for social workers is that ideology of self-determination acknowledges that individual decisions are a civilright, but that the capacity to set one’s own goals; decide what oneneeds and wants; and control how goals, needs, and wants are to be ac-tualized may be shared. We mention capacity at this point, not to sug-gest or open the door for the denial of capacity, which is too frequentlythe experience of members of marginalized and oppressed groups, andparticularly so with elderly and disabled persons, but rather to acknowl-edge that a critical role of social work is to uphold the practice ofself-determination.

Third, self-determination must engender recognition from other groupsregarding entitlement of the self-determining group not only to civil rightsbut also to equal opportunity and support in achieving both. This dimen-sion is a critical factor in our assertion of the fundamental right of rural, el-derly, disabled persons to choose their living environments, which mayinclude a full range of options from their own homes to assisted livingand nursing facilities.

Legitimacy is a concept that we have mentioned above in several in-stances. By legitimacy, we mean the values and parameters that bestowa label, category or power on an individual or group (Jost & Major,2001). Legitimacy is a value-based process whereby determinations aremade by different groups about the membership and worth of thegroups or individuals of concern. Applied to disability and elders, legit-imate disability and elder status may be promulgated by legislation,health care providers, or even disabled individuals themselves. Legiti-macy involves not only a determination of membership, but also guideshow members will be treated. Although we do not see people clamoring


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to join the ranks of the disabled elderly because of their devalued posi-tion in mainstream culture (Charlton, 1998), legitimacy as disabled, el-der or disabled elder does have its benefits in our current categoricallybased health and social service systems (Hudson, 1997; Stone, 1986).What is exchanged for those benefits in terms of seeking a legitimate la-bel of disabled elder may for some be an unwanted compromise. Thispoint brings us to the integration of self determination and legitimacy asthe ideological basis for social work practice with rural disabled elders.Attention to legitimacy is critical to understand the current systems, thevalues that shape them, why they are structured categorically, and howthey may need to be changed to meet the self determined needs of ruraldisabled elders. Embedded within this ideology, systematic, logical,and shared thinking processes are necessary to derive an accurate expla-nation for problems and points of need which provide a balancedidiographic and nomothetic social work response. Although there aremany thinking structures to meet this challenge, we have been success-ful with a technique called problem mapping (DePoy & Gilson, 2003).Let us look at this now.

PROBLEM MAPPING

Problem mapping is a systematic technique for analyzing and ex-panding our understanding of problem statements and their contexts.Further, this technique makes a clear distinction between problem andneed, in which a problem is a legitimacy statement about what is unde-sirable, and a need is an empirically supported claim of what steps arenecessary to resolve problems (DePoy & Gilson, 2003). Through thethinking process of problem mapping, the multidimensionality of prob-lems, including their explanations, causes, and consequences, can behypothesized, verified with credible evidence and linked to strategiesthat are needed to resolve all or part of the problem.

Current theory and research conducted through both nomothetic andidiographic approaches to inquiry have identified several broad prob-lem areas experienced by rural disabled elders. First, many disabled el-ders have health problems which require specialized health care services.In rural areas, in which resources are less available and accessible than inurban areas, it is highly feasible to expect that specialists will not be avail-able. Second, the limited population density of rural areas frequentlymeans that individuals are not available for employment as providers ofspecialized or assistant services. Third, transportation is most fre-


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quently private, rendering travel even to local areas difficult for thosewho are unable to drive. Fourth, housing and recreation opportunitiesare less prevalent for rural disabled elders than for rural elders and forurban dwellers. Although not a definite factor in all rural areas, limitedresources often mean underemployment and poverty. Given this varietyof life issues that are quite often faced by rural disabled elders, we haveselected the problem statement that follows to illustrate problem map-ping anchored on our ideological framework:

Using problem mapping, we would conceptualize this initial prob-lem statement as only one part of a larger phenomenon, with the meta-phor of a single rock in a river. Mapping upstream, we name theexplanatory causes for the originally articulated problem statement.Mapping downstream, we identify the consequences of the problem if itcontinues. Although these maps can be extremely complex, because weare limited in space, we present a truncated problem map for illustrationpurposes.

This problem map identifies three causal statements: (1) assumed in-competence of the rural disabled elder to make decisions about need;(2) limited housing options in rural areas for disabled elders; and (3) thelegal statutes that direct payment for attendant care services to institu-tional settings.

The consequences of the problem as initially stated are: (1) forcedinstitutionalization, (2) unnecessary expenditure of Medicaid funds for


Rural disabled elders are forced to live in nursing homesagainst their will.

Assumed Incompetence

Forced institutionalization

Limited housing options Legal statutes for Medicaid spending

Rural disabled elders are forced to live in nursing homes against their will.

Excessive spending Dissolution of family/community

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costly and unwanted institutionalization, and (3) the ultimate dissolu-tion of families and communities who do not have the resources forcommunity-based assistant services for disabled elders.

As you can see, as the initial problem statement is expanded by map-ping, so understanding of needed interventions. Using thinking strate-gies to expand problems to nomothetic and idiographic causes andconsequences provides the basis for balanced interventions within theideology of self determination. Moreover, the areas where legitimacycriteria need to be changed are clearly highlighted.

From the idiographic perspective a social worker would focus on in-dividual need. For example, in collaboration with the individual, a so-cial worker might determine the desire for alternative living options.Thus idiographically driven social work practice might involve procur-ing the financial support, home health care, and assistance with activi-ties of daily living resources that are commonly considered to beelements and experiences that define “living in the community.” Con-current with identifying and securing the needed and necessary commu-nity services, resources, and supports for the individual, the informedsocial worker would expand his or her scope to an examination of thedegree to which the occurrence of being forced to live in a nursing homeis a shared actual or potential experience for others. Along with commu-nity action, the social work response to uphold self-determinationwould seek to change public policy that currently principally supportsreimbursement for institutional health care services to in-home andcommunity based health care services.

Consider the example of The Medicaid Community-based AttendantServices And Supports Act (MiCASSA), originally introduced in 1995and reintroduced most recently in 2001 (Liberty Resources, 2001).Crafted to address the balance of nomothetic and idiographic concernsof all disabled people, this bill would be of particular value to resolvingthe problem identified above through addressing the causative factor ofinstitutionally-focused Medicaid spending patterns. Although the billhas many provisions which we cannot address here, its primary aim isthe return of control over services to the user. The bill revises Medicaidspending patterns away from nomothetically based prescription of stan-dard, institutionalized attendant services towards meeting the assistantcare needs of the disabled individual in the location and manner inwhich he/she specifies. Moreover, assistance is based on function, notdiagnosis, providing that one initially qualifies as legitimately disabledaccording to Medicaid eligibility criteria. For those who do not have thecapacity, the bill guides shared decision making among professionals,


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service users and families, as well as shared selection and supervision ofthose providing attendant services.

Social work actions of advocacy and support for MiCASSA wouldbe examples of an informed, balanced macro social work practice re-sponse to support self determination while acknowledging the issuesraised by legitimacy. The heterogeneity of the population group is notlost within categorical legitimacy, but rather would be advanced by thesocial worker who advocates for socially just responses within thenomothetic constraints of Medicaid eligibility.

PRINCIPLES FOR SOCIAL WORK PRACTICEWITH RURAL DISABLED ELDERS

As we noted above, the principles which we suggest are both posi-tive, that is what should be, and negative, what should not be. Positiveprinciples include the basic guiding ethics, values, knowledge and prac-tice principles of social work with all populations and locations.

• Begin with problem analysis.• Select the part of the problem that is within the scope of social

work practice.• Empirically determine what is needed to resolve the problem.• Set goals and objectives to meet the need through social work in-

tervention.• Thoughtfully conduct the intervention while systematically moni-

toring the degree to which process and preliminary outcomes aremeeting objectives.

• Make necessary changes in response to monitoring.• Assess the degree to which the desired outcomes met the need to

resolve the problem or part of the problem for which social workservices were initiated. (DePoy & Gilson, 2003)

Negative principles are based on legitimacy concerns.

• Do not assume that your problem definitions are in line with theproblem definitions of others.

• Do not assume homogeneity among rural disabled elders.• Do not attribute nomothetically derived characteristics to individ-

uals based on a characteristic of age, disability or rural residence.


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• Do not assume that people want or need services on the basis ofage or disability.

• Do not assume that more formal services are necessary for ruralcommunities.

• When an empirically determined need for services is asserted,identify who is making the assertion, for what purpose, who de-fines the desired outcome, and who is affected by the services.

• Based on empirical support, determine if social work ethics, val-ues, skills, and knowledge will benefit the disabled rural elders in amanner that is meaningful to and desired by them.

CONCLUSIONS

In summary:

1. We have defined the category of rural, disabled elders as a broadswath of membership, sharing some commonalities but display-ing the rich diversity that is present in all categorical descriptionsof humans.

2. We identified the ideologies of self determination and legitimacyas foundations in which this population could be viewed throughnomothetic and idiographic lenses.

3. We provided a structured thinking tool, problem mapping, for or-ganizing the complexity of problems facing the group and itsmembers.

4. Using the tool, we illustrated how an initial problem could bemapped to provide points at which needed and balanced interven-tions could be crafted and enacted.

5. We presented two levels of intervention as a sound and balancedsocial work response to a problem statement.

6. We offered positive and negative principles for practice.

In conclusion, we suggest that a major role of social work is themulti-level and collaborative effort to develop and continually improveall communities, including those that are considered to be rural. In orderto actualize this role within the ethical mandates of the social work profes-sion, concern with social justice, and respect for the full range of human di-versity, including elders and individuals with disabilities, are essential.

Drawing on current trends in research (Bickman & Rog, 1997;DePoy & Gitlin, 1998; Schutt, 1999), contemporary philosophy (Silvers,


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Wasserman, & Mahowald, 1998), new political theory (Kymlica, 2001),and even math and computer science (Gleick, 1988; Wolfram, 2002), wehave based our work and exemplars on multiple epistemologies that illu-minate central tendencies along with the context embedded uniquenessand have integrated this scholarship into our discussion of social workpractice with rural, disabled elders. We urge social workers to guidetheir practices by developing and applying systematic knowledge ofgroups and individuals, analyzing and articulating the legitimacy crite-ria that shape knowledge and action, using thinking and action pro-cesses to identify and address the complexity of social problems andneeds, and collaborating to promote communities in which a balance ismaintained between social equilibrium and individual experience.

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Documents

Chapter 10: Rural Disabled Elders